The choice between cross-attention and concatenation for multimodal fusion remains governed by practitioner intuition rather than principled understanding. In this paper, we demonstrate that feature alignment quality, not data scale alone, is the primary determinant of which fusion strategy excels. Through controlled experiments on Flickr8k using two feature extraction backbones (ResNet18 and CLIP ViT-B/32), we show that concatenation outperforms cross-attention by 4.1-5.1 percentage points across all tested scales (2048-16384 samples) when features are pre-aligned by a vision-language pretraining objective. We provide a theoretical explanation grounded in sample complexity analysis: concatenation requires O(d_v + d_t) samples to learn its fusion projection, while cross-attention requires O(d_v * d_t) samples to learn bilinear attention weights, over 256 times as many for 512-dimensional CLIP features. When features are already aligned, the approximation error gap between the two methods vanishes, and concatenation's sample efficiency dominates at all practical dataset sizes. An alignment degradation study confirms a monotonic trend: as feature alignment degrades, concatenation's advantage grows from 1.3% to 2.8%. These findings provide a principled decision framework for fusion method selection in multimodal systems, with direct implications for the design of Multimodal Large Language Models.